From Novice to Expert : Excellence and Power in Clinical Nursing Practice

by Benner, Patricia

• ISBN13: 9780201002997
• ISBN10: 020100299X
• Edition: 1st
• Format: Paperback
• Copyright: 1999-06-01
• Publisher: Prentice Hall

Summary

Winner of the 1984 American Journal of Nursing Book of the Year Award in the Nursing Education and Nursing Research categories, this landmark work is a testimonial to the importance of nursing This book provides ideas and images that nurses can draw upon in their interactions with others and in their interpretation of what nurses do. It documents nurses' concern for their clients' welfare and comfort, as well as the care that follows that concern. Based on Dr. Benner's seminal research, From Novice to Expert uses the Dreyfus Model of Skill Acquisition to explore how nurses progress in the development of expertise. It also explains the seven domains of nursing practice: helping, teaching-coaching, diagnostic and patient monitoring, effective management of rapidly changing situations, administering and monitoring therapeutic interventions and regimens, monitoring and ensuring the quality of health care practices, and organizational and work-role competencies. It includes many clear, colorful examples from actual nursing practice, as well as a special epilogue describing how the findings of this study have been applied in five major hospitals. This book is of direct and special interest to staff development educators, nursing administrators, and nurse educators in senior-level trends and issues courses.

Table of Contents

Preface	p. xvii
Uncovering the Knowledge Embedded in Clinical Nursing Practice	p. 1
Differences Between Practical and Theoretical Knowledge	p. 2
Knowledge Embedded in Expertise	p. 3
Extending Practical Knowledge	p. 4
Common Meanings	p. 6
Assumptions, Expectations, and Sets	p. 6
Paradigm Cases and Personal Knowledge	p. 8
Maxims	p. 10
Unplanned Practices	p. 10
Summary and Conclusions	p. 11
The Dreyfus Model of Skill Acquisition Applied to Nursing	p. 13
Methods	p. 14
Interpretation of Data	p. 16
Novice	p. 20
Advanced Beginner	p. 22
Competent	p. 25
Proficient	p. 27
Expert	p. 31
The Meaning of Experience	p. 36
An Interpretive Approach to Identifying and Describing Clinical Knowledge	p. 39
Performance Measurements	p. 43
Identifying Domains and Competencies	p. 44
Summary	p. 46
Domains of Nursing Practice	p. 46
The Helping Role	p. 47
The Healing Relationship: Creating a Climate for and Establishing a Commitment to Healing	p. 49
Providing Comfort Measures and Preserving Personhood in the Face of Pain and Extreme Breakdown	p. 55
Presencing: Being with a Patient	p. 57
Maximizing the Patient's Participation and Control in His or Her Own Recovery	p. 58
Interpreting Kinds of Pain and Selecting Appropriate Strategies for Pain Management and Control	p. 62
Providing Comfort and Communication Through Touch	p. 63
Providing Emotional and Informational Support to Patients' Families	p. 64
Guiding Patients Through Emotional and Developmental Change	p. 66
Summary and Conclusions	p. 75
The Teaching-Coaching Function	p. 77
Timing: Capturing a Patient's Readiness to Learn	p. 79
Assisting Patients to Integrate the Implications of Illness and Recovery into Their Lifestyles	p. 80
Eliciting and Understanding the Patient's Interpretation of His Illness	p. 84
Providing an Interpretation of the Patient's Condition and Giving a Rationale for Procedures	p. 86
The Coaching Function: Making Culturally Avoided Aspects of an Illness Approachable and Understandable	p. 89
Summary and Conclusions	p. 93
The Diagnostic and Monitoring Function	p. 95
Detection and Documentation of Significant Changes in a Patient's Condition	p. 97
Providing an Early Warning Signal: Anticipating Breakdown and Deterioration Prior to Explicit Confirming Diagnostic Signs	p. 100
Anticipating Problems: Future Think	p. 102
Understanding the Particular Demands and Experiences of an Illness: Anticipating Patient Care Needs	p. 104
Assessing the Patient's Potential for Wellness and for Responding to Various Treatment Strategies	p. 106
Summary and Conclusions	p. 107
Effective Management of Rapidly Changing Situations	p. 109
Skilled Performance in Extreme Life-Threatening Emergencies: Rapid Grasp of a Problem	p. 110
Contingency Management: Rapid Matching of Demands and Resources in Emergency Situations	p. 113
Identifying and Managing a Patient Crisis Until Physician Assistance Is Available	p. 116
Summary and Conclusions	p. 119
Administering and Monitoring Therapeutic Interventions and Regimens	p. 121
Starting and Maintaining Intravenous Therapy with Minimal Risk and Complications	p. 122
Administering Medications Accurately and Safely	p. 125
Combating the Hazards of Immobility	p. 127
Creating a Wound-Management Strategy that Fosters Healing, Comfort, and Appropriate Drainage	p. 129
Summary and Conclusions	p. 132
Monitoring and Ensuring the Quality of Health Care Practices	p. 135
Providing a Backup System to Ensure Safe Medical and Nursing Care	p. 137
Assessing What Can Be Safely Omitted from or Added to Medical Orders	p. 139
Getting Appropriate and Timely Responses from Physicians	p. 142
Summary and Conclusions	p. 143
Organizational and Work-Role Competencies	p. 145
Coordinating, Ordering, and Meeting Multiple Patient Needs and Requests: Setting Priorities	p. 146
Building and Maintaining a Therapeutic Team to Provide Optimum Therapy	p. 149
Coping with Staff Shortages and High Turnover	p. 151
Summary and Conclusions	p. 160
Implications for Research and Clinical Practice	p. 163
Involvement versus Distance	p. 163
Nurse-Patient Relationships	p. 165
Early Warning Signals	p. 166
Outside the Boundaries of Nursing	p. 168
Monitoring and Organizational Skills	p. 169
The Phenomenon of Caring	p. 170
Implications for Career Development and Education	p. 173
Career Development	p. 174
Nursing Education	p. 184
The Quest for a New Identity and New Entitlement in Nursing	p. 195
Meaningful Incentives and Reward Systems	p. 199
A Clinical Promotion System	p. 202
Increased Collaborative Relationships	p. 204
Increased Recognition	p. 204
Excellence and Power in Clinical Nursing Practice	p. 207
Transformative Power	p. 210
Integrative Caring	p. 211
Advocacy	p. 212
Healing Power	p. 213
Participative/Affirmative Power	p. 213
Problem Solving	p. 214
Epilogue Practical Applications	p. 221
Research Application: Identifying the Use and Misuse of Formal Models in Nursing Practice	p. 225
Implementation of Staff Nurse III at El Camino Hospital	p. 244
Focus on Excellence	p. 258
Identification of the Skilled Performance of Masters Prepared Nurses as a Method of Curriculum Planning and Evaluation	p. 262
Building Bridges Between Education and Practice	p. 275
References	p. 285
Glossary	p. 291
Appendix	p. 299
Index	p. 303
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